FNP 590 HTN CASE STUDYMr. Smith is a 64-year-old African American male. He was diagnosed with hypertension and hyperlipidemia 5 years ago and has not taken meds regularly for the last year. He states he has been experiencing chest pain when working around the house and sometimes while on his evenin...
fnp 590 htn case study mr smith is a 64 year old african american male he was diagnosed with hypertension and hyperlipidemia 5 years ago and has not taken meds regularly for the last year he
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, Mr. Smith is a 64-year-old African American male. He was diagnosed with
hypertension and hyperlipidemia 5 years ago and has not taken meds regularly for the last
year. He states he has been experiencing chest pain when working around the house and
sometimes while on his evening walk. He also complains that his feet are swelling in the
evening. His vitals today: P-105, B/P-165/100, R-20. Wt-260 Ht-5’9” Labs: TC- 240, LDL-
145, HDL- 30, Trig-250. Sulfa allergy. You are assigned as his new PCP.
Hypertension is a major preventable factor in disease and death in the United States that
contributes to stroke, kidney disease, and heart attacks. African Americans have a higher
incidence of hypertension and its related comorbidities than other races. Hypertension is the
leading cause of cardiovascular disease in the United States. Inadequate control of blood pressure
is often multifactorial, with poor diet, physical inactivity, nonadherence to medication, patient-
knowledge deficits, and lack of social support, all contributing (Lackland, 2014). Mr. Smith is at
risk for several comorbidities. Mr. Smith is an obese African American male who has
hypertension stage II, hyperlipidemia, and angina and does not adhere to medication
management.
What medication recommendations will you make? Include the drug class, generic and
trade name, and starting dose range. Provide rationale for your choices.
Data are consistent in showing that diuretics or calcium-channel blockers are more effective as
monotherapy than other drug classes among African American patients with hypertension. The
combination of a diuretic with a calcium-channel blocker has been recommended in some recent
guidelines (Ojji et al.,2019). Diuretics and calcium channel blockers are considered more
effective for African American males with hypertension, whereas, ACE inhibitors, β blockers,
and ARBs are expressed as less effective for African American males with hypertension
(Lackland, 2014). With this in mind and the fact that our patient is allergic to sulfa, I would place
Mr. Smith on Spironolactone 25 mg QD, Diltiazem 180mg, Lipitor 10mg QD, and Aspirin 81 mg
QD.
1. Spironolactone (Aldactone) is a potassium-sparing diuretic and is a mineralocorticoid
receptor antagonist. Spironolactone can be found for as low as $10.82/ 90 tablets per
GoodRx. This medicine is used to treat high blood pressure, and edema or swelling from
heart, kidney, or liver disease. It can also be used to treat patients who make too much
aldosterone or have low potassium (Wolters, 2017, p. 2081-2082). This is the safest
diuretic for Mr. Smith due to his sulfa allergy. Since I will be using four new medications
I will start at the lowest dose of 25 mg QD. This will allow Mr. Smith’s body to adjust to
the medication without bottoming his blood pressure. With Mr. Smith’s history of
noncompliance, we want to use QD medications that are affordable whenever possible.
Side Effects: Hyperkalemia can be noted especially in patients with renal impairment.
Hyponatremia and gynecomastia can also be side effects. Mr. Smith needs to keep a
blood pressure and daily weight logs to bring to his next appointment in two weeks. At
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